Provider Demographics
NPI:1528173192
Name:HEBERLE, PAUL W (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:HEBERLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:18244 IRISH ROAD
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-0573
Mailing Address - Country:US
Mailing Address - Phone:814-734-3633
Mailing Address - Fax:814-734-1349
Practice Address - Street 1:18244 IRISH RD
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-4734
Practice Address - Country:US
Practice Address - Phone:814-734-3633
Practice Address - Fax:814-734-1349
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008790L207P00000X, 207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018002500008Medicaid
PA0018002500008Medicaid
PA039259Medicare ID - Type Unspecified